CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) by: Dr. Saad Al Asiri MD, DLO, KSF, Rhino General Secretary Assistant for Training & Program Accreditation ENT Consultant and Rhinologist

 Definition: long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and permanent perforation

Tubotympanic (safe)atticoantral (unsafe) Dischargeprofuse mucoidscanty purulent Foul smell PerforationcentralMarginal GranulationuncommonCommon PolyppaleRed, fleshy CholesteatomabsentPresent ComplicationrareCommon Audiogrammild, moderate, conductive, deafness Conductive or mixed deafness TYPES Differences between atticoantral and tubotympanic type of CSOM

 Chronic non - suppurative OM "no pus, no perforation” A - OM with effusion B - adhesive OM  Chronic suppurative OM " pus + perforation A - tubotympanic safe B - atticoantral unsafe  OME - OM with effusion → done by Dr. Samir Classification of Chronic OM

 Etiology  Environmental  Genetic  Previous OM + effusion  URTI  ET dysfunction  C/E  otorrhea - details  Deafness  Other FN, pain, blood discharge  R/O complication

 Otoscopic finding  Discharge  Perforation  Central  Attic "marginal“  Polyp  Granulation  Tympanosclerosis

 Eustachian Tube " E T"  Surgical anatomy  Difference between infant and adult  Function –  ventilation and regulation of m. Ear  pressure protection e.g. Reflex of secretion  Nasopharynx  Clearance of M. Ear secretion

 Causes of ET obstruction  URTI + sinusitis  Allergy, N. Polyp  Severly DNS  Adenoid  Cleft palate

 Total obstruction ↓  Absorption of ME gases ↓  Negative pressure in ME ↓  Retraction of TM ↓  Transudate in ME + hemorrhage ↓  OM effusion ↓  Atelectatic ear " no M. Ear space" ↓  Retraction pocket ↓  Cholesteatoma

 Classification of cholestreatoma  Congenital  Acquired  Pathogenesis of cholesteatoma  Migration of sq. Epithelium  Metaplasia

 Clinical symptoms → indicating complication in CSOM  Pain  Vertigo  Persistent headache  Facial weakness  Fever & vomiting  Irritability & neck rigidity  Diplopia  Ataxia  Abscess around the ear

 Bacteriology  Mixed organism aerobes + aneorbes  Investigation  Ear swab  Microscopic examination  Imaging  Audiology

 Treatment  Ear toilet  Ear drops  Ear swab C/S

 When surgery is indicating  To improve hearing  To prevent discharge  Any complication  Myringoplasty  Tympanoplasty  Mastoidectomy 3/5/2016

 Effects of cholesteatoma  Focus of infection "Persistent"  Bone erosion where to go "explain“  Complication of suppurative otitis media

 Factors influencing development of complication  Age  Poor socioeconomic group  Virulence of organisms  Immunity of patient  Presence of cholesteatoma 3/5/2016

 Pathway of spread of infection  Direct of bone erosion  Venous thrombophatitis  Preformed pathways  Dehiscence  Patent suture  Post surgery  Oval and round window

A. Intratemporal within temporal bone  Mastoiditis  Petrositis  F.n. Paralysis due acute & chronic labyrinthitis + lab  Fistua

A. Intracranial  Extradural abscess "the commenist "  Subdural abscess  Meningitis  Brain abscess - 50% ear isthe cause of brain abscess  Hydrocephalus 3/5/2016

 Investigation:  CT  MRI  Treatment  Manage ear infection  Manage the complication

3/5/2016